Lindsay Lohan’s Relapse and Court-Mandated AA

Imagine that you had cancer and a judge mandated that you receive a treatment first introduced in the 1930s — one that had been described, by the world’s leading medical evidence–review group, as having “no experimental studies [that] unequivocally demonstrated [its] effectiveness.”

That’s the sort of situation in which Lindsay Lohan finds herself as she faces the consequences of her relapse (she failed a drug test last Friday and a judge on Monday issued an arrest warrant for her). She is required to attend meetings of 12-step groups like Alcoholics Anonymous to deal with her alcohol and cocaine addictions — but there’s no evidence that 12-step groups are superior to other treatments, particularly when they are coerced. In fact, some studies of drunk drivers mandated to attend AA found that they were more likely to drink than those who were not required to attend meetings. (More on Time.com:Photos: Women-in-Prison Movies)

The evidence that does support 12-step groups — and there is a great deal of this — is mainly related to people choosing them for themselves. Those who attend when it is not required or who continue attending when they aren’t forced to do so do have superior outcomes in terms of abstinence, reductions in drinking and psychological health.

Even 12-step programs themselves recognize that coercion cannot create lasting recovery. Members talk about “attraction not promotion” as the way to help get others join. Another slogan is: “This is a program for people who want it, not people who need it.”

Further, every federal court that has looked at the question has also found that mandating AA violates the separation of church and state, making forced 12-step programs not only in violation of the spirit of AA itself but also unconstitutional.

Of course, relapse is common in addiction and Lindsay’s slip may have had nothing to do with which kind of care she received. But if addiction is a disease, why are judges rather than doctors making treatment decisions? If people with other mental illnesses commit crimes, judges do not dictate what care their psychiatrists provide. Why should addiction be different? (More on Time.com: Top 10 Ridiculous Celebrity Lawsuits)

[For more about addiction and recovery, see my series that starts here today, The Addiction Files]